Drug Prevention

Last week, a resurgent Republican Party retook control of the US House of Representatives, giving the Democrats a drubbing the likes of which has not been seen for decades. The Democrats lost 61 seats, seeing their side sink to 189 seats to the Republicans' 240. They needed 218 to take over again.

The change in control of the House has some serious drug policy implications. There's bad news, but maybe also some good news.

Reform measures passed in the current Congress, such as repealing the bans on federal funding of needle exchange programs and implementation of the Washington, DC, medical marijuana program, could see attempts to roll them back. And pending reforms efforts, such as the battle to repeal the HEA student loan provision, are probably dead. Reform friendly Democratic committee chairs, who wield considerable power, have been replaced by hostile Republicans.

But the incoming Republicans made slashing the deficit and cutting the federal budget a winning campaign issue for themselves, and will be looking for programs they can cut or eliminate. That could open the door to hacking away at programs that support the ongoing prosecution of the drug war, but it could also open the door for cuts in prevention and treatment programs.

As the Chronicle noted here earlier this week, it's not just Tea Party types who want to wield the budget ax. The mainstream conservative Heritage Foundation issued a report just before election day laying out a whopping $434 billion in federal budget cuts, including eliminating the Office of National Drug Control Policy, the drug task force-funding Justice Assistance Grant (JAG, formerly the Byrne grant program) program, and the Safe and Drug Free Schools and Communities state grant program.

"Budgetary issues is where I'm most optimistic," said Bill Piper, veteran national affairs director for the Drug Policy Alliance. "Given the fiscal climate, there could be real cuts in the federal budget. Next year is probably an unprecedented opportunity to de-fund the federal drug war. These new Republicans are a different breed—anti-government, anti-spending, pro-states' rights, and some are proven to be prone to bucking the leadership. If the Republican leadership votes to preserve the drug war, they may rebel," he said.

"We can go after the Byrne grant program," Piper enthused. "That's a very important deal. If we can cut off drug war funding to the states, the states won't be able to afford their punitive policies anymore. During the recession in the Bush administration, when the administration was cutting money to the states, a lot of states passed reform measures because they couldn't afford to lock people up. This time, the federal government has been bailing out state criminal justice systems, but if we can cut or eliminate Byrne grants, the states won't have money for their drug task forces and imprisoning people. Then they will have to consider reforms like cutting sentences and making marijuana possession an infraction."

"Sentencing reform on budgetary grounds is possible," said Kara Gotsch, director of advocacy for the Sentencing Project. "From our perspective, that is a way to reduce government spending. If you want to reduce drug war spending, you reduce costs by investing in prevention and substance abuse programs. That will be part of our talking points, but the reality is, to be successful they're going to have to be bipartisan."

Eric Sterling, former House Judiciary Committee counsel and current head of the Criminal Justice Policy Foundation was less sanguine than either Piper or Gotsch about the urge to cut the deficit leading to progress in drug reform. "The prospect of saving money leading to criminal justice and drug policy reform is remote," said Sterling. "In state legislatures where they have to balance the budget, everyone recognizes what has to happen. But in Congress, they know there is still going to be a deficit."

Sterling also questioned just how different the Republican freshman class will be from traditional Republicans. "That's a big question mark," he said. "They are younger and bring with them different experiences about drug policy or marijuana in particular, but most of these men and women won by using traditional themes that most incumbent Republicans used, too. I think for them, cracking down on drugs and crime will have more value than trying to save money by funding diversion or correctional programs that aren't about harsh punishment."

But Piper remained upbeat. "Next year is probably an unprecedented opportunity for the movement to defund the drug war. The stars are aligning. A lot of tax groups are already on record for cutting some of these programs," he noted. "Given the fiscal climate, we could see considerable cuts in the federal budget. The type of Republicans coming into office, as well as Obama's own need to show he can practice fiscal discipline, means a real chance to cut or eliminate some of those programs," he said. "The down side is that funding for prevention and treatment is likely to come under fire, too."

Rep. Lamar Smith (R-TX) -- no friend of drug reform.

While budget battles will be fought in appropriations committees, criminal justice issues are a different matter. One of the most striking changes comes in the House Judiciary Committee, where pro-drug reform Democrats like chairman John Conyers (D-MI) and Subcommittee on Crime, Terrorism, and Homeland Security chair Bobby Scott (D-VA) are being replaced by the likes of Rep. Lamar Smith (R-TX), who will head the Judiciary Committee. Smith, a conservative old school drug warrior, was the only congressman to speak up against passage of the bill to reduce the disparity in crack and powder cocaine sentences.

He also authored a bill this fall that would have made it a federal offense for US citizens to plan to commit acts outside the US that would violate US drug laws. While that bill was allegedly aimed at large drug trafficking organizations, it could have made federal criminals out of college students making plans to visit the coffee shops of Amsterdam. He took to Fox News last month to lambaste the Obama administration as insufficiently tough on marijuana law enforcement, a clip he displays on his web site (scroll over the small video screens; the title will pop up).

"The fact that Rep. Smith is going to be the chair will definitely have an impact," said Gotsch. "He was the only vocal opposition to the crack cocaine sentencing reform, and the fact that he is now going to be chair is discouraging. It indicates that he won't be thoughtful about sentencing reforms for low level drug offenders."

"The Democratic committee chairs were good on drug policy and unlikely to advance bad drug war bills," said Piper. "Now, with Conyers and Scott gone and Lamar Smith in charge, we can expect stuff like Smith's foreign drug conspiracy bill to come out of that committee."

"You couldn’t find bigger champions for reform than Scott and Conyers," said Gotsch. "We won't have them as chairs now; that's probably the biggest disappointment to our community."

"Smith has been quite out there in his attacks over the drug issue," said Sterling. "My hunch is that we will take advantage of the political attractiveness of the drug issue to try to have both oversight hearings and legislation that would be embarrassing to Democrats."

And don't expect too much from the Democrats, either, he added. "The Democratic caucus is going to be more reluctant to deal with the drug issue in a progressive way than it has been," said Sterling. "They see it as a distraction from the heart of the message they need to bring to retake power in 2012."

With people like Smith holding key House committee positions, the drug reform agenda is likely to stall in the next Congress. Instead, reformers will be fighting to avoid reversing earlier gains.

"In terms of passing good things, there probably wasn’t a lot more that was going to happen with Democrats before 2012," said Piper. "The important low hanging fruit of overturning the syringe ban, the DC medical marijuana ban, and the crack sentencing bill had already gotten through. We might have been able to achieve repeal of the HEA drug provision, but probably not now."

The drug reform movement's job now will be not only blocking bad legislation, but also fighting to prevent a rollback of drug reform victories in the current Congress, such as the repeal of the bans on syringe exchange funding and implementing the Washington, DC, medical marijuana law, said Piper.

"They're unlikely to go backwards on crack, but the syringe ban and the DC medical marijuana ban were both repealed with some, but not a lot, of Republican support," he said. "The syringe ban repeal barely passed, and that was in a Congress dominated by Democrats. Will they try to restore the syringe funding ban and overturn DC's medical marijuana program? That's our big fear. Hopefully, we can scrape up enough votes to defeat in the House, or stop it on the Senate side," he said.

Piper also dared to dream of an emerging Republican anti-drug war caucus. "We don't know who these new Republicans all are, but some have probably been influenced by Ron Paul (R-TX)," he said. "If only 10 of them stand up against the drug war, that's a huge opportunity to raise hell in the Republican caucus. Almost a third of Republican voters want to legalize marijuana, and that's an opportunity for us, too. Maybe there will be Republicans we can work with and create a truly bipartisan anti-drug war coalition in Congress. That's a foothold."

For Piper, the future looks stormy and cloudy, but "the silver lining is in appropriations fights and opportunities to organize an anti-drug war movement in the Republican caucus. We just have to play defense on a bunch of stuff," he said.

"The activist community is going to have to figure out what the recipe for our lemonade is," advised Sterling. "That requires first a redoubled effort at organizing, using themes such as the wise stewardship of the scarce resources we have, and what works and what is effective," he said.

"It also requires mobilizing people not involved in this issue before, whether it's the business community or people who see their rice bowls been broken by the Republican approach," Sterling continued. "Teachers, nurses, people asking how come the part of the public work force this is protected is the police and the police guards. Drug policy reform activists have to think about what are the alliances they can make in this time of public resource scarcity."

Seeking to address the fact that in 17 states prescription drug combination overdoses kill more people than traffic accidents, and that prescription drug related treatment admissions have recently increased 400%, the DEA will collect your unused medications, no questions asked. But will this straightforward strategy really address the rise in addictions and death? The data suggest that the issue is more complicated than you think.

In 2005, Montana had one of the highest rates of methamphetamine use in the country, and businessman Thomas Siebel responded with the Montana Meth Project, an anti-meth campaign relying on graphic advertisements feature users' bodies decaying, teen girls prostituting themselves for meth, teens committing violent crimes to support their habits, and groups of young meth users allowing their friends to die.

The project has been widely touted as reducing meth use rates in Montana, and the Montana Meth Project makes similar claims on its results page. Based on claimed results in Montana, similar programs have gotten underway in Arizona, Idaho, Illinois, Wyoming, Colorado, Hawaii and, this past March, Georgia.

But a new study from the University of Washington published in this month's issue of the Journal of Health Economics casts doubt on the project's claim to have influenced meth use rates. The rate of meth use in Montana was already declining by the time the Montana Meth Project got underway, the study found.

"Methamphetamine use was trending downward already, and the research shows that the project has had no discernable impact on meth use," said study author D. Mark Anderson, a UW doctoral student in economics.

Anderson said the project had not been empirically and rigorously scrutinized until his study. Using data from Youth Risk Behavior Surveys conducted by the Centers for Disease Control and Prevention, Anderson compared meth use rates to rates nationwide and in nearby states. Using demographically similar Wyoming and North Dakota, which undertook no anti-meth project programs, as control cases, Anderson showed that in all three states, meth use declined gradually between 1999 and 2009.

Anderson also scrutinized drug treatment admission reports from the Substance Abuse and Mental Health Services Administration (SAMHSA) and found that the Montana Meth Project had no measurable effect on meth use among young Montanans. His findings suggested that other factors, such as law enforcement crackdowns prior to 2005 or increasing knowledge of the ill-effects of meth use, were more likely to have led to declining levels of meth use.

"Perhaps word got around on the street, long before the campaign was adopted, that meth is devastating," Anderson said. "Future research, perhaps of meth projects in the other states, should determine whether factors that preceded the campaigns contributed to decreases in usage."

For the second year, graphic television ads showing actors portraying pathetic and physically damaged drug addicts remind people about the danger of methamphetamine -- but does the scary message work? "It does not prevent future use. They're not effective," Jeanne Y. Ohta, executive director of the Drug Policy Forum of Hawaii, says of the frightening TV commercial prepared by the Hawaii Meth Project.

A leaked draft of the overdue 2010 National Drug Strategy was published by Newsweek over the weekend, and it reveals some positive shifts away from Bush-era drug policy paradigms and toward more progressive and pragmatic approaches. But there is a lot of continuity as well, and despite the Obama administration's rhetorical shift away from the "war on drugs," the drug war juggernaut is still rolling along.

sign of the leaker?

That doesn't quite jibe with Office of National Drug Control Policy (ONDCP -- the drug czar's office) director Gil Kerlikowske's words when he announced in April 2009 that the phrase "war on drugs" was no longer in favor. "Regardless of how you try to explain to people it's a 'war on drugs' or a 'war on a product,' people see a war as a war on them. We're not at war with people in this country."

The leak was reported by long-time Washington insider and Newsweek columnist Michael Isikoff, who mentioned it almost off-handedly in a piece asserting "The White House Drug Czar's Diminished Status." Isikoff asserted in the piece that the unveiling of the strategy had been delayed because Kerlikowske didn't have the clout to get President Obama to schedule a joint appearance to release it. His office had been downgraded from cabinet level, Isikoff noted.

That sparked an angry retort from UCLA professor Mark Kleiman, a burr under the saddle to prohibitionists and anti-prohibitionists alike for his heterodox views on drug policy. In a blog post, Kleiman seemed personally offended at the leak, twice referring to the leaker as "a jerk," defending the new drug strategy as innovative if bound by interagency politics, and deriding Isikoff's article as "gossipy."

Kleiman also suggested strongly that the leaker was none other than former John Walters on the basis of an editing mark on the document that had his name on it. But Walters has not confirmed that, and others have point out it could have been a current staffer who is using the same computer Walters used while in office.

On the plus side, the draft strategy embraces some harm reduction programs, such as needle exchanges and the use of naloxone to prevent overdoses, although without ever uttering the words "harm reduction." There is also a renewed emphasis on prevention and treatment, with slight spending increases. But again reality fails to live up to rhetoric, with overall federal drug control spending maintaining the long-lived 2:1 ration in spending for law enforcement, eradication, and interdiction versus that for treatment and prevention.

The strategy also promotes alternatives to incarceration, such drug courts, community courts and the like and for the first time hints that it recognizes the harms that can be caused by the punitive approach to drug policy. And it explicitly calls for reform of the sentencing disparity for crack and powder cocaine offenses.

It sets a number of measurable goals related to reducing drug use. By 2015, ONDCP vows to cut last month drug use by young adults by 10% and cut last month use by teens, lifetime use by 8th graders, and the number of chronic drug users by 15%.

The 2010 goals of a 15% reduction reflect diminishing expectations after years of more ambitious drug use reduction goals followed by the drug policy establishment's inability to achieve them. That could inoculate the Obama administration from the kind of criticism faced by the Clinton administration back in the 1990s when it did set much more ambitious goals.

While Clinton took criticism from Republicans that his goals were not ambitious enough -- Newt Gingrich said we should just wipe out drugs -- the Bush administration set similar goals, and achieved similarly modest results. The Bush administration's 2002 National Drug Control Strategy sought a 25% reduction in drug use by both teenagers and adults within five years. While teen drug use declined from 11.6% in 2002 to 9.3% in 2007, then drug czar Walters missed his goal. He did less well with adult use almost unchanged, at 6.3% in 2000 and 5.9% in 2007.

The draft strategy, however, remains wedded to law enforcement, eradication, and interdiction, calls for strong federal support for local drug task forces, and explicitly rejects marijuana legalization. It also seeks to make drugged driving a top priority, which would be especially problematic if the administration adopts per se zero tolerance measures (meaning the presence of any metabolites of a controlled substance could result in a driver's arrest whether he was actually impaired or not).

Still, while the draft strategy is definitely a mixed bag, a pair of keen observers of ONDCP and federal drug policy pronounced themselves fairly pleased overall. While still heavy on the law enforcement side, the first Obama national drug strategy is a far cry from the propaganda-driven documents of Bush era drug czar John Walters.

The Good

"This is somewhat of a surprise, because for the first time they have included reducing the funds associated with the drug war in their strategy, although not in a big way, they're calling for reform of the crack/powder cocaine sentencing disparity, and they are calling for the reform of laws that penalize people," said Bill Piper, national affairs director for the Drug Policy Alliance. "This is the first time they've included anything recognizing that some of our policies are creating harm," he added.

"The stuff about syringe exchange and naloxone for overdose prevention is pretty good. It's the first time they've embraced any part of harm reduction, even though they don't use that name," Piper noted.

"I'm also impressed with the section on alternatives to incarceration," said Piper. "They basically said most drug users don't belong in jail, and a lot of dealers don't, either. It's still wedded to the criminal justice system, but it's good that they looked at so many different things -- drug courts, community courts, Operation Highpoint (warning dealers to desist instead of just arresting them as a means of breaking up open-air drug markets), programs for veterans. They seem interested in finding out what works, which is an evidence-based approach that had been lacking in previous strategies."

The Status Quo

"Drug war reformers have eagerly been waiting the release of President Obama's first National Drug Control Strategy," noted Matthew Robinson, professor of Government and Justice Studies at Appalachian State University and coauthor (with Renee Scherlen) of "Lies, Damned Lies, and Drug War Statistics: A Critical Analysis of Claims Made by the ONDCP." "Would it put Obama's and Kerlikowske's words into action, or would it be more of the same in terms of federal drug control policy? The answer is yes. And no. There is real, meaningful, exciting change proposed in the 2010 Strategy. But there's a lot of the status quo, too," he said.

"The first sentence of the Strategy hints at status quo approaches to federal drug control policy; it announces 'a blueprint for reducing illicit drug use and its harmful consequences in America,'" Robinson said. "That ONDCP will still focus on drug use (as opposed to abuse) is unfortunate, for the fact remains that most drug use is normal, recreational, pro-social, and even beneficial to users; it does not usually lead to bad outcomes for users, including abuse or addiction," he said.

"Just like under the leadership of Director John Walters, Kerlikowske's ONDCP characterizes its drug control approaches as 'balanced,' yet FY 2011 federal drug control spending is still imbalanced in favor of supply side measures (64%), while the demand side measures of treatment and prevention will only receive 36% of the budget," Robinson pointed out. "In FY 2010, the percentages were 65% and 35%, respectively. Perhaps when Barack Obama said 'Change we can believe in,' what he really meant was 'Change you can believe in, one percentage point at a time.'"

There is also much of the status quo in funding levels, Robinson said. "There will also be plenty of drug war funding left in this 'non-war on drugs.' For example, FY 2011 federal drug control spending includes $3.8 billion for the Department of Homeland Security (which includes Customs and Border Protection spending), more than $3.4 billion for the Department of Justice (which includes Drug Enforcement Agency spending), and nearly $1.6 billion for the Department of Defense (which includes military spending). Thus, the drug war will continue on under President Obama even if White House officials do not refer to federal drug control policy as a 'war on drugs,'" he noted.

The Bad

"ONDCP repeatedly stresses the importance of reducing supply of drugs into the United States through crop eradication and interdiction efforts, international collaboration, disruption of drug smuggling organizations, and so forth," Robinson noted. "It still promotes efforts like Plan Colombia, the Southwest Border Counternarcotics Strategy, and many other similar programs aimed at eradicating drugs in foreign countries and preventing them from entering the United States. The bottom line here is that the 'non war on drugs' will still look and feel like a war on drugs under President Obama, especially to citizens of the foreign nations where the United States does the bulk of its drug war fighting."

"They are still wedded to interdiction and eradication," said Piper. "There is no recognition that they aren't very effective and do more harm than good. Coming only a couple of weeks after the drug czar testified under oath that eradication in Colombia and Afghanistan and elsewhere had no impact on the availability of drugs in the US, to then put out a strategy embracing what he said was least effective is quite disturbing."

"The ringing endorsement of per se standards for drugged driving is potentially troubling," said Piper. "It looks a lot like zero tolerance. We have to look at this also in the context of new performance measures, which are missing from the draft. In the introduction, they talk about setting goals for reducing drug use and that they went to set other performance measures, such as for reducing drug overdoses and drugged driving. If they actually say they're going to reduce drugged driving by such and such an amount with a certain number of years, that will be more important. We'll have to see what makes it into the final draft."

"They took a gratuitous shot at marijuana reform," Piper noted. "It was unfortunate they felt the need to bash something that half of Americans support and to do it in the way they did, listing a litany of Reefer Madness allegations and connecting marijuana to virtually every problem in America. That was really unfortunate."

More Good

There are some changes in spending priorities. "Spending on prevention will grow 13.4% from FY 2010 to FY 2011, while spending on treatment will grow 3.7%," Robinson noted. "The growth in treatment is surprisingly small given that ONDCP notes that 90% of people who need treatment do not receive it. Increases are much smaller for spending on interdiction (an increase of 2.4%), domestic law enforcement (an increase of 1.9%), and international spending (an increase of 0.9%). This is evidence of a shift in federal drug control strategy under President Obama; there will be a greater effort to prevent drug use in the first place as well as treat those that become addicted to drugs than there ever was under President Bush."

Robinson also lauded the Obama administration for more clarity in the strategy than was evident under either Clinton or Bush. "Obama's first Strategy clearly states its guiding principles, each of which is followed by a specific set of actions to be initiated and implemented over time to achieve goals and objectives related to its principles. Of course, this is Obama's first Strategy, so in subsequent years, there will be more data presented for evaluation purposes, and it should become easier to decipher the ideology that will drive the 'non war on drugs' under President Obama," he said.

But he suggested that ideology still plays too big a role. "ONDCP hints at its ideology when it claims that programs such as 'interdiction, anti-trafficking initiatives, drug crop reduction, intelligence sharing and partner nation capacity building... have proven effective in the past.' It offers almost no evidence that this is the case other than some very limited, short-term data on potential cocaine production in Colombia. ONDCP claims it is declining, yet only offers data from 2007 to 2008. Kerlikowske's ONDCP seems ready to accept the dominant drug war ideology of Walters that supply side measures work -- even when long-term data show they do not."

Robinson also lauded ONDCP's apparent revelation that drug addiction is a disease. "Obama's first strategy embraces a new approach to achieving federal drug control goals of 'reducing illicit drug consumption' and 'reducing the consequences of illicit drug use in the United States,' one that is evidence-based and public health oriented," Robinson said. "ONDCP recognizes that drug addiction is a disease and it specifies that federal drug control policy should be assisted by parties in all of the systems that relate to drug use and abuse, including families, schools, communities, faith-based organizations, the medical profession, and so forth. This is certainly a change from the Bush Administration, which repeatedly characterized drug use as a moral or personal failing."

While the Obama drug strategy may have its faults, said Robinson, it is a qualitative improvement over Bush era drug strategies. "Under the Bush Administration, ONDCP came across as downright dismissive of data, evidence, and science, unless it was used to generate fear and increased punitive responses to drug-related behaviors. Honestly, there is very little of this in Obama's first strategy, aside from the usual drugs produce crime, disorder, family disruption, illness, addiction, death, and terrorism argument that has for so long been employed by ONDCP," he said. "Instead, the Strategy is hopeful in tone and lays out dozens of concrete programs and policies that aim to prevent drug use among young people (through public education programs, mentoring initiatives, increasing collaboration between public health and safety organizations); treat adults who have developed drug abuse and addiction problems (though screening and intervention by medical personnel, increased investments in addiction treatment, new treatment medications); and, for the first time, invest heavily in recovery efforts that are restorative in nature and aimed at giving addicts a new lease on life," he noted.

"ONDCP also seems to suddenly have a better grasp on why the vast majority of people who need treatment do not get it," said Robinson. "Under Walters, ONDCP claimed that drug users were in denial and needed to be compassionately coerced to seek treatment. In the 2010 Strategy, ONDCP outlines numerous problems with delivery of treatment services including problems with the nation's health care systems generally. The 2010 Strategy seems so much better informed about the realities of drug treatment than previous Strategy reports," he added.

"The strategy also repeatedly calls for meaningful change in areas such as alternatives to incarceration for nonviolent, low-level drug offenders; drug testing in courts (and schools, unfortunately, in spite of data showing it is ineffective); and reentry programs for inmates who need help finding jobs and places to live upon release from prison or jail. ONDCP also implicitly acknowledges that that federal drug control policy imposes costs on families (including the break-up of families), and shows with real data that costs are greater economically for imprisonment of mothers and foster care for their children than family-based treatment," Robinson noted.

"ONDCP makes the case that we are wasting a lot of money dealing with the consequences of drug use and abuse when this money would be better spent preventing use and abuse in the first place. Drug policy reformers will embrace this claim," Robinson predicted.

"The strategy also calls for a renewed emphasis on prescription drug abuse, which it calls 'the fastest growing drug problem in the United States,'" Robinson pointed out. "Here, as in the past, ONDCP suggests regulation is the answer because prescription drugs have legitimate uses that should not be restricted merely because some people use them illegally. And, as in the past, ONDCP does not consider this approach for marijuana, which also has legitimate medicinal users in spite of the fact that some people use it illegally," he said.

The Verdict

"President Obama's first National Drug Control Strategy offers real, meaningful, exciting change," Robinson summed up. "Whether this change amounts to 'change we can believe in' will be debated by drug policy reformers. For those who support demand side measures, many will embrace the 2010 Strategy and call for even greater funding for prevention and treatment. For those who support harm reduction measures such as needled exchange, methadone maintenance and so forth, there will be celebration. Yet, for those who support real alternatives to federal drug control policy such as legalization or decriminalization, all will be disappointed. And even if Obama officials will not refer to its drug control policies as a 'war on drugs,' they still amount to just that."

Gil Kerlikowske, head of the Office of National Drug Control Policy (ONDCP -- the drug czar's office), testified on Capitol Hill Wednesday that the Obama administration is seeking "a new direction in drug policy," but was challenged both by lawmakers and by a panel of academics and activists on the point during the same hearing. The action took place at a hearing of the House Domestic Policy Subcommittee in which the ONDCP drug budget and the forthcoming 2010 National Drug Strategy were the topics at hand.

The hearing comes in the wake of various drug policy reforms enacted by the Obama administration, including a Justice Department policy memo directing US attorneys and the DEA to lay off medical marijuana in states where it is legal, the removal of the federal ban on needle exchange funding, and administration support for ending or reducing the sentencing disparity between crack and powder cocaine offenders.

But it also comes in the wake of the announcement of the ONDCP 2011 drug budget, which at $15.5 billion is up more than $500 million from this year. While treatment and prevention programs got a 6.5% funding increase, supply reduction (law enforcement, interdiction, and eradication) continues to account for almost exactly the same percentage of the overall budget -- 64%--as it did in the Bush administration. Only 36% is earmarked for demand reduction (prevention and treatment).

Citing health care costs from drug use and rising drug overdose death figures, the nation "needs to discard the idea that enforcement alone can eliminate our nation's drug problem," Kerlikowske said. "Only through a comprehensive and balanced approach -- combining tough, but fair, enforcement with robust prevention and treatment efforts -- will we be successful in stemming both the demand for and supply of illegal drugs in our country."

So far, at least, when it comes to reconfiguring US drug control efforts, Kerlikowske and the Obama administration are talking the talk, but they're not walking the walk. That was the contention of subcommittee chair Rep. Dennis Kucinich (D-OH) and several of the session's panelists.

"Supply side spending has not been effective," said Kucinich, challenging the budget breakdown.

"Supply side spending is important for a host of reasons, whether we're talking about eradication or our international partners where drugs are flowing," replied the drug czar.

"Where's the evidence?" Kucinich demanded. "Describe with statistics what evidence you have that this approach is effective."

Kerlikowske was reduced to citing the case of Colombia, where security and safety of the citizenry has increased. But he failed to mention that despite about $4 billion in US anti-drug aid in the past decade, Colombian coca and cocaine production remain at high levels.

"What parts of your budget are most effective?" asked Kucinich.

"The most cost-effective approaches would be prevention and treatment," said Kerlikowske.

Rep. Darrell Issa (R-CA) was more old school, demanding a tougher response to Mexico's wave of prohibition-related violence and questioning the decision not to eradicate opium in Afghanistan. "The Southwest border is critical. I would hope the administration would give you the resources you need for a Plan Colombia on steroids," said Issa.

"There is no eradication program in Afghanistan," Issa complained. "I was in areas we did control and we did nothing about eradication."

"I don't think anyone is comfortable seeing US forces among the poppy fields," Kerlikowske replied. "Ambassador Holbrooke has taken great pains to explain the rationale for that," he added, alluding to Holbrooke's winning argument that eradication would push poppy farming peasants into the hands of the Taliban.

"The effectiveness of eradication seems to be near zero, which is very interesting from a policy point of view," interjected Rep. Bill Foster (D-IL).

Kucinich challenged Kerlikowske about harm reduction. "At the UN, you said the US supported many interventions, but you said that, 'We do not use the phrase harm reduction.' You are silent on both syringe exchange programs and the issue of harm reduction interventions generally," he noted. "Do you acknowledge that these interventions can be effective in reducing death and disease, does your budget proposed to fund intervention programs that have demonstrated positive results in drug overdose deaths, and what is the basis of your belief that the term harm reduction implies promotion of drug use?"

Kerlikowske barely responded. "We don't use the term harm reduction because it is in the eye of the beholder," he said. "People talk about it as if it were legalization, but personally, I haven't spent a lot of time thinking about whether to put a definition on it."

When challenged by Kucinich specifically about needle exchange programs, Kerlikowske conceded that they can be effective. "If they are part of a comprehensive drug reduction effort, they make a lot of sense," he said.

The grilling of Kerlikowske took up the first hour of the two-hour session. The second hour consisted of testimony from Drug Policy Alliance executive director Ethan Nadelmann, Brookings Institute foreign policy fellow and drugs and counterinsurgency expert Vanda Felbab-Brown, former ONDCP employee and drug policy analyst John Carnevale, and University of Maryland drug policy expert Peter Reuter. It didn't get any better for drug policy orthodoxy.

"Let me be frank," said Nadelmann as he began his testimony. "We regard US drug policy as a colossal failure, a gross violation of human rights and common sense," he said, citing the all too familiar statistics about arrests, incarceration, the spread of HIV/AIDS, and drug overdose deaths. "All of these are an egregious violation of fundamental American values."

"Congress and the Obama administration have broken with the costly and failed drug war strategies of the past in some important ways," said Nadelmann. "But the continuing emphasis on interdiction and law enforcement in the federal drug war budget suggest that ONDCP is far more wedded to the failures of the past than to any new vision for the future. I urge this committee to hold ONDCP and federal drug policy accountable to new criteria that focus on reductions in the death, disease, crime and suffering associated with both drugs and drug prohibition."

Nadelmann identified four problems with current drug strategy:

The drug war's flawed performance measures;

The lop-sided ratio between supply and demand spending in the national drug budget;

The lack of innovation in the drug czar's proposed strategies;

The administration's failure to adequately evaluate drug policies.

"They want to move toward a public health model that focuses on reducing demand for drugs, but no drug policy will succeed unless there are the resources to implement it," said Carnevale. "Past budgets emphasizing supply reduction failed to produce results, and our drug policy stalled -- there has been no change in overall drug use in this decade."

Carnevale noted that the 2011 ONDCP budget gave the largest percentage increase to prevention and treatment, but that its priorities were still skewed toward supply reduction. "The budget continues to over-allocate funds where they are least effective, in interdiction and source country programs."

"The drug trade poses multiple and serious threats, ranging from threats to security and the legal economy to threats to legality and political processes," said Felbab-Brown, "but millions of people depend on the illegal drug trade for a livelihood. There is no hope supply-side policies can disrupt the global drug trade."

Felbab-Brown said she was "encouraged" that the Obama administration had shifted toward a state-building approach in Afghanistan, but that she had concerns about how policy is being operationalized there. "We need to adopt the right approach to sequencing eradication in Afghanistan," she said. "Alternative livelihoods and state-building need to be comprehensive, well-funded, and long-lasting, and not focused on replacing the poppy crop."

"Eradication in Afghanistan has little effect on domestic supply and reduction," said Kucinich. "Should these kinds of programs be funded?"

"I am quite convinced that spending money for eradication, especially aerial eradication, is not effective," replied Carnevale. "The point of eradication in Colombia was to reduce the amount of drugs coming into the US, but I see no such effect."

"We're dealing with global commodity markets," said Nadelmann. "If one source is knocked out, someone else will pop up. What's missing is any sort of strategic analysis or planning. If you accept that these drugs are going to be produced, you need to manage it to reduce the harms."

"The history of the last 20 years of the cocaine and heroin trade shows how much mobility there is in cultivation and trafficking," said Reuter. "What we do has a predictable effect. When we pushed down on trafficking in Florida, that lead to increases in Mexico. The evidence is striking that all we are doing is moving the trade."

Times are changing in Washington. What was once unassailable drug war orthodoxy is not under direct assault, and not just from activists and academics, but among members of Congress itself. But while the drug czar talks the happy talk about "new directions in drug policy," the Obama administration -- with some notable exceptions -- looks to still have a drug policy on cruise control.

The Obama administration released its Fiscal Year 2011 budget proposal this week, including the federal drug control budget. On the drug budget, the Obama administration is generally following the same course as the Bush administration and appears to be flying on autopilot.

According to the Office of National Drug Control Policy (ONDCP -- the drug czar's office), the administration is requesting $15.5 billion for drug control, an increase of 3.5% over the current budget. Drug law enforcement funding would grow from $9.7 billion this year to $9.9 billion in 2011, an increase of 5.2%. Demand side measures, such as prevention and treatment, also increased from $5.2 billion this year to $5.6 billion next year.

The $15.5 billion dollar drug budget actually undercounts the real cost of the federal drug war by failing to include some significant drug policy-driven costs. For instance, operations for the federal Bureau of Prisons are budgeted at $8.3 billion for 2011. With more than half of all federal prisoners serving time for drug offenses, the real cost of current drug policies should increase by at least $4 billion, but only $79 million of the prisons budget is counted as part of the national drug strategy budget.

The Obama drug budget largely maintains the roughly two-to-one imbalance between spending on treatment and prevention and spending on law enforcement. Drug Czar Gil Kerlikowske called the imbalanced budget "balanced."

Highlights and lowlights:

Funding for the Substance Abuse and Mental Health Services Administration prevention programs (SAMHSA) is set at $254.2 million, up $29.6 million from this year, while funding for SAMHSA treatment programs is set at $635.4 million, up $101.2 million from this year.

Funding for ONDCP's Drug Free Communities program is set at $85.5 million, down $9.5 million from this year.

Funding for the widely challenged National Youth Anti-Drug Media Campaign is set at $66.5 million, an increase of more than 50% over this year.

The Arrestee Drug Abuse Monitoring II program (ADAM) is funded at $10 million. It got no money this year.

Funding for the Department of Health and Human Services Substance Abuse Prevention and Treatment program is set at $1.799 billion, the same as this year.

Funding for the Second Chance Act for reintegrating people completing prison sentences is set at $50 million, a whopping 66% increase over this year.

Funding for the Justice Department's Organized Crime Drug Enforcement Task Force is set at $579.3 million, up $50.8 million over this year.

Funding for the High Intensity Drug Trafficking Areas (HIDTA) program is set at $210 million, down $29 million from this year.

Funding for the Defense Department's counternarcotics efforts in Afghanistan is set at $501.5 billion, up about one-third over this year.

Funding for State Department counternarcotics activities in West Africa is set at $13.2 million, up $10 million from this year.

Funding for State Department counternarcotics activities in Colombia is set at $178.6 million, down $26.6 million from this year.

Funding for the DEA is set at $2.131 billion, up 5.5% over this year. That pays for 8,399 employees, 4,146 of whom are DEA agents.

"The new budget proposal demonstrates the Obama administrations' commitment to a balanced and comprehensive drug strategy," said Kerlikowske. "In a time of tight budgets and fiscal restraint, these new investments are targeted at reducing Americans' drug use and the substantial costs associated with the health and social consequences of drug abuse."

Drug reformers tended to disagree with Kerlikowske's take on the budget. "This is certainly not change we can believe in," said Bill Piper, national affairs director for the Drug Policy Alliance. "It's extremely similar to the Bush administration drug budgets, especially in terms of supply side versus demand side. In that respect, it's extremely disappointing. There's nothing innovative there."

"This budget reflects the same Bush-era priorities that led to the total failure of American drug policy during the last decade," said Aaron Houston, director of government relations for the Marijuana Policy Project. "One of the worst examples is $66 million requested for the National Youth Anti-Drug Media Campaign when every independent study has called it a failure. The president is throwing good money after bad when what we really need is a new direction."

Houston also took umbrage with the accounting legerdemain that continues to allow ONDCP to understate the real cost of federal drug policies. "It's disconcerting to see the Obama administration employ the same tactics in counting the drug budget that the Bush administration did," said Houston. "Congress told ONDCP in 2006 to stop excluding certain items from the budget, and we had a Democratic committee chairman excoriate John Walters over his cooking of the books, but it doesn't appear they've done anything to stop that. Maybe they have to cook the books to make this look like a successful program."

But reformers also noted that some good drug policy news had already come out of the Obama administration. They also suggested that the real test of Obama's direction in drug policy would come in March, when Kerlikowske releases the annual national drug control strategy.

"I'm a little disappointed," said Keith Stroup, founder of the National Organization for the Reform of Marijuana Laws, "but I think there is a significant difference in the environment from the Bush years. Maybe not in this budget, but things like issuing those Department of Justice regulations on medical marijuana have made a major difference."

"They are unwilling or unable to change the drug war budget, but the true measure of their commitment to a shift in drug policy will be the national drug control strategy that comes out in a few weeks," said Piper. "The question is will their drug strategy look like Bush's and like their drug budget does, or will they articulate a new approach to drug policy more in line with the president's comments on the campaign trail that drug use should be treated as a public health issue, not a criminal justice one."

The Obama administration's decision to not interfere with medical marijuana in the states was one example of a paradigm shift, said Piper. So was its support for repealing the federal needle exchange funding ban and ending the sentencing disparity between crack and powder cocaine offenses.

"In a lot of ways, the budget trimming that comes out of the White House is a fraud because they know Congress won't make those cuts," said Piper. "I wonder if that's the game Obama is playing with the Byrne grants. That's the kind of thing they can articulate in the drug strategy if they wanted to. They should at least talk about the need to shift from the supply side to the demand side approach. They could even admit that this year's budget does not reflect that, but still call for it."

This is only the administration's budget request, of course. What it will look like by the time Congress gets through with it is anybody's guess. But it strongly suggests that, so far, there's not that much new under the sun in the Obama White House when it comes to the drug budget.

Harm reduction in New York City came under attack last weekend when the tabloid New York Post ran an article titled Heroin for Dummies, excoriating the city for spending $32,000 for a 2007 harm reduction pamphlet that, among other things, gave injection drug users advice on how to reduce the harm of injecting. Since then, the story has been picked up by the New York Times and national media, including CNN and Fox News.

uncomfortable, but the right thing to do

But while the assault on evidence-based harm reduction practices is worrisome, it also sparked a vigorous defense of the pamphlet from Mayor Michael Bloomberg and city health officials and has provided an opportunity to broaden public awareness of harm reduction. By Thursday, despite demands that they be pulled, Health Commissioner Thomas Farley had decided that the pamphlets will continue to be distributed.

The pamphlet, Take Charge, Take Care, was distributed by the city's Department of Health and Mental Hygiene and was aimed at injection drug users in the city. The harm reduction purpose behind it was to save lives and prevent overdoses and the spread of blood-borne disease. It counsels things like quitting, not sharing needles, and seeking treatment.

But also included in its advice were things like "Find the vein before you try to inject," "If you don't register [hit the vein], pull out and try again," and "Warm your body (jump up and down) to show your veins." Such common-sense harm reduction advice was like waving a red flag for Post and the drug warriors it interviewed.

"It's basically step-by- step instruction on how to inject a poison," said John Gilbride, head of the DEA's New York office. "It concerns me that the city would produce a how-to on using drugs," Gilbride said. "Heroin is extremely potent. You may only get the chance to use it once. To suggest there is a method of using that alleviates the dangers, that's very disturbing."

"It's sick," said City Council member Peter Vallone Jr. (D-Queens), chair of the council's public safety committee, who vowed to try to shut down distribution of the pamphlet. "This is a tremendous misuse of city funds, and I'm going to see what I can do to stop it. It sends a message to our youth: give it a try," he fumed.

"What we do not want to do is suggest that there's anything safe about shooting up narcotics," said Bridget Brennan, the city's special narcotics prosecutor. "No matter how many times you wash your hands or how clean the needle is, it's still poison that you're putting in your veins."

Only at the very end of the Post article was any supporter of harm reduction or the pamphlet given a say. "Our goal is to promote health and save lives with this information," explained Daliah Heller, assistant commissioner for the Bureau of Alcohol and Drug Use Prevention, Care and Treatment. "From a health perspective, there is a less harmful way to inject yourself."

The New York Times article the following day was less one-sided than the Post's hit piece, but still gave Vallone and other critics top billing. "You're spending taxpayer money and getting a how-to guide for first-time users," Vallone claimed.

The pamphlet was "absolutely not" a how-to manual, Dr. Adam Karpati, executive deputy commissioner for the health department's division of mental hygiene, told the Times. "Our primary message, as it is in all our initiatives, is to help people stop using drugs and to provide them with information on how to quit," Karpati said, adding that health officials recognized that quitting was not a realistic expectation for all drug users.

While Karpati was playing defense, harm reduction supporters went on the offensive. "The Health Department's booklet is solidly grounded in science and public health," said Ethan Nadelmann, executive director of the Drug Policy Alliance. "But the same cannot be said of the irresponsible comments by John Gilbride, Bridget Brennan, and Peter Vallone, Jr. These sorts of reckless statements by top level city and federal law enforcement agents need to be repudiated by their superiors in city and federal government."

On Monday, Mayor Bloomberg defended the pamphlet. "I would certainly not recommend to anyone that they use hard drugs or soft drugs," Bloomberg said. "But our health department does have an interest in if you're going to do certain things to get you to do it as healthily as you possibly can."

Now that the flap is behind them, two leading harm reductionists are assessing what it all means. "There was a political agenda at work with this," said Allan Clear, head of the Harm Reduction Coalition. "The District Attorney's Office fed this to the Post. This is a deliberate attack, and it follows on the footsteps of Rockefeller drug law reform, where DAs had some of their power stripped away. This was a red rag for foes to wave to provoke people, when the amount spent on the brochure is relatively small."

"This was not a book for people who have never injected," said Robert Heimer, professor at the Yale School of Public Health. "We know that people use opiates for around three years before they start injecting, and they don't do it because of a pamphlet, but because they are following their friends' example. This pamphlet was distributed at needle exchanges, STD clinics, drug treatment centers, and to people leaving Rikers Island. That's who the audience is, not people who have never injected."

Neither Clear nor Heimer thought much of the press coverage, although Clear was more charitable to the Times than Heimer. "The brochure has been deceptively portrayed consistently in all the articles," said Clear. "This is a manual aimed at people who are using injection drugs. The first thing it says is if you want help, call this number. If you compare the articles in the Post and the Times, the anti-drug user invective in the Post was just horrendous and demonstrated a very biased position to begin with," said Clear. "The conversation in the Times was much more pro-public health and sympathetic."

"The Times article was incredibly negative," said Heimer. "The first eight or ten paragraphs were all the opposition, and only after that do you get to the health department and why it's a common sense public health approach. When you have 'liberal media' like the Times and rightwing Murdoch papers like the Post both condemning you, you are under a lot of pressure to change."

When all is said and done, did the pamphlet flap turn out to be a boon or a bane for harm reduction? Again, the two men differed.

"When you get this on Fox News or CNN and people are talking about it, even though the initial effort was to discredit the brochure, it actually brought harm reduction to public consciousness in a good way," said Clear. "While we feel attacked, there has been a lot of positive response, and this has raised the profile of harm reduction and the need to educate drug users. The public reaction hasn't been that bad; in fact, it's been quite good."

"Any time there is negative press, it's not good for harm reduction," said Heimer. "It's still fragile here. In places like Holland, Britain, Canada, and Australia, harm reduction is one of the four pillars -- prevention, treatment, law enforcement, harm reduction -- but in this country, very little is done about prevention, there is not enough drug treatment because there is not enough emphasis on demand reduction, and we spend all our money on supply reduction, and we know how that has worked."

Pete Guither has a great post mocking the bizarre, yet common, observation that the drug problem would go away if everyone stopped taking drugs.

This is like saying "If everyone stopped having sex, we could eliminate STDs, abortions, and unwanted pregnancies." True, but absurd — not even worthy of a science fiction short story.

Indeed, anyone who complains that everybody should just stop taking drugs is basically admitting that they have no remotely reasonable ideas for dealing with the problems that result from drug use. We, on the other hand, have lots of ideas about that. And unlike the ridiculous strategy of trying to end all drug use, our plan for ending the drug war instead seems to be looking more realistic every day.

US House and Senate negotiators in conference committee approved the finishing touches on the Fiscal Year 2010 budget Tuesday night, and they included a number of early Christmas presents for different drug reform constituencies. It isn't quite a done deal yet -- this negotiated version of the FY 2010 Consolidated Appropriations Act must now win final approval on both the House and Senate floors. But they are up-or-down, no-amendments-allowed votes -- if the bill passes, it will include the drug reforms.

US Capitol, Senate side

What the conference committee approved:

Ending the ban on federal funding for needle exchange programs -- without previous language that would have banned them from operating within 1,000 feet of schools, parks, and similar facilities. (Instead it seems to give local authorities the ability to overrule state or other officials on location choices.)

Ending the ban on the use of federal funds for needle exchanges in the District of Columbia.

Allowing the District of Columbia to implement the medical marijuana initiative passed by voters in 1998 but blocked by congressional diktat ever since.

Cutting funding for the Office of National Drug Control Policy's National Youth Anti-Drug Media Campaign from $70 million this year to $45 million next year.

In a news release after agreement was reached, this is how the committee described the language on needle exchange:

Modifies a prohibition on the use of funds in the Act for needle exchange programs; the revised provision prohibits the use of funds in this Act for needle exchange programs in any location that local public health or law enforcement agencies determine to be inappropriate.

Its description of the DC appropriations language:

Removing Special Restrictions on the District of Columbia: ...Also allows the District to implement a referendum on use of marijuana for medical purposes as has been done in other states, allows use of Federal funds for needle exchange programs except in locations considered inappropriate by District authorities.

And its language on the youth media campaign:

National Youth Anti-Drug Media Campaign: $45 million, $25 million below 2009 and the budget request, for a national ad campaign providing anti-drug messages directed at youth. Reductions were made in this program because of evaluations questioning its effectiveness. Part of the savings was redirected to other ONDCP drug-abuse-reduction programs.

Citing both reforms in the states -- from medical marijuana to sentencing reform -- as well as the conference committee's actions, Drug Policy Alliance executive director Ethan Nadelmann stopped just short of declaring victory Wednesday. "It's too soon to say that America's long national nightmare -- the war on drugs --is really over," Nadelmann. "But yesterday's action on Capitol Hill provides unprecedented evidence that Congress is at last coming to its senses when it comes to national drug control policy."

As noted above, there are still two votes to go, and reformers are applying the pressure until it is a done deal. "Hundreds of thousands of Americans will get HIV/AIDS or hepatitis C if Congress does not repeal the federal syringe funding ban," said Bill Piper, DPA national affairs director. "The science is overwhelming that syringe exchange programs reduce the spread of infectious diseases without increasing drug use. We will make sure the American people know which members of Congress stand in the way of repealing the ban and saving lives."

Washington, DC, residents got a two-fer from the committee when it approved ending the ban on the District funding needle exchanges and undoing the Barr Amendment, the work of erstwhile drug warrior turned reformer former Rep. Bob Barr (R-GA). Barr's amendment forbade the District from implementing the 1998 medical marijuana initiative, which won with 69% of the vote.

"Congress is close to making good on President Obama's promise to stop the federal government from undermining local efforts to provide relief to cancer, HIV/AIDS and other patients who need medical marijuana," said Naomi Long, the DC Metro director of the Drug Policy Alliance. "DC voters overwhelmingly voted to legalize marijuana for medical use and Congress should have never stood in the way of implementing the will of the people."

"The end of the Barr amendment is now in sight," said Aaron Houston, director of government relations for the Marijuana Policy Project. "This represents a huge victory not just for medical marijuana patients, but for all city residents who have every right to set their own policies in their own District without congressional meddling. DC residents overwhelmingly made the sensible, compassionate decision to pass a medical marijuana law, and now, more than 10 years later, suffering Washingtonians may finally be allowed to focus on treating their pain without fearing arrest."

Medical marijuana in the shadow of the Capitol? Federal dollars being spent on proven harm reduction techniques? Congress not micromanaging DC affairs? What is the world, or at least Washington, coming to?